Please provide the last 5 years of your residential history leaving no gaps (from 2012 to the present date)

Current address:

From Date*:

Street number*:

Street name*:

APT. number:

P.O. BOX:

Postal Code*:

City*:

Province/State*:

Country*:

Is your mailing address same as your residential address?

YesNo

(If not, please provide your current mailing address below)

Previous addresses:

(If applicable)

From Date:

To Date:

Full address

From Date:

To Date:

Full address

From Date:

To Date:

Full address

From Date:

To Date:

Full address

From Date:

To Date:

Full address

Please provide the last 5 years of your employment history leaving no gaps (from 2012 to the present date):

(if you are currently not employed, please type Unemployed / Retired / Student / Minor in the occupation field)

Current employment:

From Date*:

Occupation*

Full address

Company Name

Phone number

Previous employment:

(If applicable)

From Date:

To Date:

Occupation

Full address

Company Name

Phone number

From Date:

To Date:

Occupation

Full address

Company Name

Phone number

From Date:

To Date:

Occupation

Full address

Company Name

Phone number

From Date:

To Date:

Occupation

Full address

Company Name

Phone number

From Date:

To Date:

Occupation

Full address

Company Name

Phone number

Have you ever been convicted of an offence in any country for which you have not received a pardon? .............................

YesNo

Have you ever received a waiver of inadmissibility to the U.S. from a U.S. government agency? ........................................

YesNo

Have you ever been approved by Citizenship and Immigration Canada for rehabilitation because of past criminal activity?

YesNo

Have you ever been found in violation of customs or immigration laws or other federal import laws? ..................................

YesNo

If you have answered YES to any of the above questions, please explain briefly below, including the date and country where you were convicted:

Travel history - If not applicable, please write "NONE":

If you have travelled outside of North America (Canada, the United States and its territories, and Mexico) in the past five years you must list the countries where you have travelled. The list does not have to follow any order but it must include all trips. Please note that visits to England, Scotland, Wales, or Northern Ireland should be labelled as “United Kingdom”. If you have visited a particular country more than once, you only have to list the country one time.

Non-custodial adult parents or guardians must attach a copy of supporting documents such as a court order or letter of authorization if this application is for a child under the age of 18 who will be travelling with the non-custodial adult.

For applicants under 18 years of age, please complete the following information:

Legal Guardian Surname:

Legal Guardian First Name:

Legal Guardian Date Of Birth:

MaleFemale

Preferred interview location:

(Interviews take place at the main Canadian airports or at the US/Canada border)

One application per person is required. Every individual who would like to apply for membership - children included and multiple applicants in one household - have to submit a separate application, and schedule a separate interview appointment upon conditional approval.